Individual
MISS COURTNEY RENEE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
4300 SW 13TH ST, GAINESVILLE, FL 32608-4006
(352) 374-5600
Mailing address
336 NW PRIMITIVE GLN, LAKE CITY, FL 32055-8577
(469) 422-7141
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
262749
FL
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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